Long read: Why Every Third Indian Child Is Still Underweight

As we watch the breathtaking skills on display in the football World Cup in North America, we can’t but help wonder why in its 70-years of Independence, India has never got close to qualifying for this elite tournament. After all, if tiny Cabo Verde, Ebola impacted Democratic Republic of Congo and heavily-sanctioned Iran can qualify for the World Cup, why can’t India? The answer lies in the decades old indifference of India’s leadership to the nutritional requirements of the vast majority of Indians. As this hard-hitting piece in IndiaSpend explains, the vast majority of Indian children (85% to be precise) do NOT get an adequate diet!

Every few years, a new round of the National Family Health Survey (NFHS) data lands and gives India a report card on how well it is feeding its children. The headlines this time are the kind that could go either way depending on which number you pick: stunting is down sharply, but underweight and wasting are barely moving.

IndiaSpend’s Prachi Salve digs into why, and the answer she arrives at says as much about India’s economy as it does about its health system.

Start with the good news. Stunting, where a child is short for their age, has fallen from 35.5% in 2019-21 to 29.3% in 2023-24 per NFHS-6. That matters because, as a 2017 Gates Foundation report put it:

“Stunting is a proxy for overall cognitive and physical underdevelopment. Stunted children will be less healthy and productive for the rest of their lives, and countries with high rates of stunting will be less prosperous.”

But height is only half the story, and the other half has barely budged. Nearly two in five children are still “wasted,” meaning their weight is too low for their height, and about a third remain underweight. As Veena Shatrugna, former deputy director of the National Institute of Nutrition, told IndiaSpend: “If children are growing taller but not putting on weight proportionately, then underweight and wasting remain concerns.”

What explains the gap? Better maternal healthcare and disease prevention, mostly. Antenatal care visits, iron-folic acid supplementation, institutional deliveries and immunisation have all improved nationally, and states that pushed hardest on these fronts, like Jharkhand and Andhra Pradesh, saw the biggest stunting declines. Fewer childhood infections mean fewer disruptions to growth, since, as Shatrugna notes, “when children fall sick repeatedly, that’s when they stop putting on height.” Feeding practices have improved too: early breastfeeding within an hour of birth rose from 42% to 50%, and complementary feeding for infants aged 6-8 months rose from 46% to 60%.

None of this, though, has translated into a genuinely better diet. Only 15.3% of children aged 6-23 months receive what NFHS-6 defines as an “adequate diet,” and exclusive breastfeeding under six months actually fell, from 64% to 56%. The piece’s most striking line comes from Amulya Nidhi of Jan Swasthya Abhiyan: “Malnutrition is fundamentally an economic problem. Food diversity matters. The key question is whether families are actually able to access it.” Shatrugna is blunter still: “How can you improve dietary variety without improving incomes? Varieties will only come if families have money. How will they buy eggs, milk, fruits and vegetables if incomes are stagnant?”

That is the uncomfortable thread running through this data. India’s public systems, its immunisation drives, its food security net, its healthcare access, have gotten meaningfully better at keeping children alive and growing in height. What they have not fixed is the household budget. Cereals have gone from 22% of food spending to about 5% over two decades, but that saved money has not obviously gone toward eggs, pulses or vegetables in the quantities nutritionists want. As IFPRI’s Purnima Menon points out, feeding a child well also takes “time, patience and care,” not just money, which is its own constraint on households already stretched thin.

It is a familiar pattern for anyone who has watched Indian macro data over the years: aggregate progress that masks a stubborn, income-shaped floor beneath it. You can vaccinate a child, treat their diarrhoea and get their mother to the hospital on time. Getting an egg onto their plate every day turns out to be the harder problem.

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